Pain Catastrophizing and Pain Self-Efficacy Mediate Interdisciplinary Pain Rehabilitation Program Outcomes at Posttreatment and Follow-Up

Abstract Background Decreasing pain catastrophizing and improving self-efficacy to self-manage chronic pain symptoms are important treatment targets in the context of interdisciplinary cognitive behavioral therapy for chronic pain. Greater pain catastrophizing has been shown to be associated with greater impact of pain symptoms on functioning, while conversely, greater pain self-efficacy has been associated with lower pain intensity and lower levels of disability. Objective To prospectively evaluate interdisciplinary cognitive behavioral therapy for pain outcomes, as well as to the mediating effects of both pain catastrophizing and pain self-efficacy on outcome. Methods Participants were 315 patients with chronic pain between April 2017 and April 2018 who completed a three-week interdisciplinary pain rehabilitation program. Pain severity, pain interference, pain catastrophizing, pain self-efficacy, quality of life, and depressive symptom questionnaires, and measures of physical performance were assessed at pre- and posttreatment. Follow-up questionnaires were returned by 163 participants. Effect size and reliable change analyses were conducted from pre- to posttreatment and pretreatment to 6-month follow-up. Mediation analyses were conducted to determine the mediating effect of pain catastrophizing and pain self-efficacy on pain outcome. Results Significant improvements from pre- to posttreatment in pain outcomes were observed, and over 80% evidenced reliable change in at least one pain-relevant measure. Pain catastrophizing and pain self-efficacy mediated the relationship between changes in pain outcomes. Conclusions Interdisciplinary pain rehabilitation is an effective treatment and decreasing pain catastrophizing and increasing pain self-efficacy can influence maintenance of treatment gains.

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Moderators of Internet-Delivered Cognitive-Behavioral Therapy for Adolescents With Chronic Pain: Who Benefits From Treatment at Long-Term Follow-Up?

Journal of Pain ◽

10.1016/j.jpain.2019.10.001 ◽

2020 ◽

Vol 21 (5-6) ◽

pp. 603-615

Author(s):

Caitlin B. Murray ◽

Rocio de la Vega ◽

Dorothy M. Loren ◽

Tonya M. Palermo

Keyword(s):

Chronic Pain ◽

Cognitive Behavioral Therapy ◽

Behavioral Therapy ◽

Cognitive Behavioral ◽

Long Term Follow Up

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Cognitive Behavioral Therapy for Depression and Anxiety in an Interdisciplinary Rehabilitation Program for Chronic Pain: a Randomized Controlled Trial with a 3-Year Follow-up

International Journal of Behavioral Medicine ◽

10.1007/s12529-017-9690-z ◽

2017 ◽

Vol 25 (1) ◽

pp. 55-66 ◽

Cited By ~ 13

Author(s):

Magnús Ólason ◽

Rúnar H. Andrason ◽

Inga H. Jónsdóttir ◽

Hlín Kristbergsdóttir ◽

Mark P. Jensen

Keyword(s):

Chronic Pain ◽

Randomized Controlled Trial ◽

Cognitive Behavioral Therapy ◽

Behavioral Therapy ◽

Controlled Trial ◽

Rehabilitation Program ◽

Depression And Anxiety ◽

Randomized Controlled ◽

Interdisciplinary Rehabilitation

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Cognitive Behavioral Therapy, Self-Efficacy, and Depression in Persons with Chronic Pain

Pain Management Nursing ◽

10.1016/j.pmn.2012.02.006 ◽

2013 ◽

Vol 14 (4) ◽

pp. e236-e243 ◽

Cited By ~ 18

Author(s):

Virginia R. Nash ◽

Julie Ponto ◽

Cynthia Townsend ◽

Pamela Nelson ◽

Miranda N. Bretz

Keyword(s):

Chronic Pain ◽

Cognitive Behavioral Therapy ◽

Self Efficacy ◽

Behavioral Therapy ◽

Cognitive Behavioral

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Efficacy of Cognitive Behavioral Therapy in Managing Chronic Pain of Degenerative Conditions: An Overview of Randomized Clinical Trials and Meta-Analysis Studies

Journal of Preventive and Rehabilitative Medicine ◽

10.21617/jprm2020.215 ◽

2020 ◽

Vol 2 (1) ◽

pp. 27-31

Author(s):

Nchawanangwa Kaonga ◽

◽

Charity Kapenda ◽

James Mwanza ◽

Brian Chanda Chiluba ◽

...

Keyword(s):

Chronic Pain ◽

Cognitive Behavioral Therapy ◽

Randomized Clinical Trials ◽

Cognitive Distortions ◽

Pain Catastrophizing ◽

Behavioral Therapy ◽

Meta Analysis ◽

Good Evidence ◽

Cognitive Behavioral ◽

Relaxation Techniques

Background:Cognitive behavioral therapy is a goal-oriented psychotherapy treatment that takes a hands-on, practical approach to problem-solving. It has been documented in various studies to have an impact when used in the management of chronic pain. It has been shown to lack the drawbacks of pharmacological and surgical treatments such as addiction and toxicity; and cost and recovery time, respectively. Cognitive behavioral therapy has also been shown to target cognitive distortions such as pain catastrophizing among other things. The objective of the review is to evaluate the effectiveness of cognitive behavioral therapy in the management of chronic pain of degenerative conditions. Methods:This review article was conducted basing on the previous studies published from 2009-2019 and data analyzed was retrieved from Google Scholar, Elsevier and Science Direct. Only the articles that looked at effectiveness of cognitive behavioral therapy in the management of chronic pain from a physiotherapists point were included. Results:The outcomes of the studies used varied and included reduction in pain intensity, pain disability, fear avoidance, catastrophizing and kinesophobia. The CBT approaches used across the studies also varied and included operant conditioning, biofeedback, relaxation techniques, pacing, cognitive coping techniques, graded activity and graded exposure.Conclusion:Published randomized controlled trials provide good evidence for the effectiveness of cognitive behavioral therapy and how specific approaches may vary in effectiveness depending on the desired outcomes

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A Novel Exercise Facilitation Method in Combination with Cognitive Behavioral Therapy Using the Ikiiki Rehabilitation Notebook for Intractable Chronic Pain: Technical Report and 22 Cases

Healthcare ◽

10.3390/healthcare9091209 ◽

2021 ◽

Vol 9 (9) ◽

pp. 1209

Author(s):

Shinji Kimura ◽

Masako Hosoi ◽

Naofumi Otsuru ◽

Madoka Iwasaki ◽

Takako Matsubara ◽

...

Keyword(s):

Chronic Pain ◽

Cognitive Behavioral Therapy ◽

Rating Scale ◽

School Attendance ◽

Numerical Rating Scale ◽

Pain Catastrophizing ◽

Behavioral Therapy ◽

Cognitive Behavioral ◽

Technical Report ◽

Numerical Rating

Recent clinical practice guidelines for chronic pain indicate, with a high evidence level, that the combination of exercise and cognitive behavioral therapy (CBT) is effective. The purpose of this study was to evaluate the effectiveness of an exercise facilitation method in combination with CBT using the “Ikiiki Rehabilitation Notebook” for patients with intractable chronic pain. “Ikiiki” means active in Japanese. A total of 22 cases with chronic low back (n = 13), lower extremity (n = 8), or neck (n = 1) pain were treated using this notebook. Two cases dropped out, leaving 22 cases. Each case was evaluated in terms of the numerical rating scale (NRS) of the pain, activities of daily living (ADL), pain catastrophizing scale (PCS), and quality of life (QOL) at pretreatment and post-treatment. The endpoint of the method was to achieve the long-term goals set by the patients. The mean treatment period was 11.2 months. The outcomes were as follows: improvement of presenteeism: nine cases; enhanced participation in hobbies: seven cases; improved school attendance: two cases; return to work: one case; improvement of self-care and/or self-efficacy: three cases. The NRS, ADL, PCS, and QOL were significantly improved after the treatment. This method is possibly valuable for educating patients about the cause and treatment of chronic pain and actively facilitating exercise and social participation. Further studies are needed to investigate the effectiveness of using this notebook for the patient with intractable chronic pain.

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Preoperative cognitive–behavioral therapy for reducing pain catastrophizing and improving pain outcomes after total knee replacement: a randomized clinical trial

Regional Anesthesia and Pain Medicine ◽

10.1136/rapm-2020-102258 ◽

2021 ◽

pp. rapm-2020-102258

Author(s):

Asokumar Buvanendran ◽

Amanda C Sremac ◽

Patricia A Merriman ◽

Craig J Della Valle ◽

John W Burns ◽

...

Keyword(s):

Cognitive Behavioral Therapy ◽

Pain Catastrophizing ◽

Behavioral Therapy ◽

Phase 1 ◽

Cognitive Behavioral ◽

Womac Pain ◽

Phase 2 ◽

Pain Subscale ◽

Pain Outcomes ◽

Total Knee

IntroductionCognitive–behavioral therapy (CBT) can reduce preoperative pain catastrophizing and may improve postsurgical pain outcomes. We hypothesized that CBT would reduce pain catastrophizing more than no-CBT controls and result in improved pain outcomes.MethodsThe study was a randomized controlled trial of patients undergoing elective total knee arthroplasty between January 2013 and March 2020. In phase 1, the change in pain catastrophizing scores (PCS) among 4-week or 8-week telehealth, 4-week in person and no-CBT sessions was compared in 80 patients with a PCS >16. In phase 2, the proportion of subjects that achieved a 3-month decrease in Western Ontario and McMaster Universities Osteoarthritis (WOMAC) pain subscale >4 following 4-week telehealth CBT with no-CBT controls were compared in 80 subjects.ResultsIn phase 1, 4-week telehealth CBT had the highest completion rate 17/20 (85%), demonstrated an adjusted median reduction in PCS of −9 (95% CI −1 to −14, p<0.01) compared with no-CBT and was non-inferior to 8-week telehealth CBT at a margin of 2 (p=0.02). In phase 2, 29 of 35 (83%) in the 4-week telehealth CBT and 26 of 33 (79%) subjects in the no-CBT demonstrated a decrease in the WOMAC pain subscale >4 at 3 months, difference 4% (95% CI −18% to 26%, p=0.48), despite a median decrease in the PCS for the 4-week CBT and no-CBT group of −6 (−10 to −2, p=0.02).ConclusionsOur findings demonstrate that CBT interventions delivered prior to surgery in person or via telehealth can reduced PCS scores; however, this reduction did not lead to improved 3-month pain outcomes.Trial registration numberClinicalTrials.gov (NCT 01772329, registration date 21 January 2013).

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Internet-Based Cognitive Behavioral Therapy for Children and Adolescents With Dental Anxiety: Open Trial (Preprint)

10.2196/preprints.7803 ◽

2017 ◽

Author(s):

Shervin Shahnavaz ◽

Erik Hedman-Lagerlöf ◽

Tove Hasselblad ◽

Lena Reuterskiöld ◽

Viktor Kaldo ◽

...

Keyword(s):

Cognitive Behavioral Therapy ◽

Children And Adolescents ◽

Outcome Measures ◽

Self Efficacy ◽

Primary Outcome ◽

Behavioral Therapy ◽

Dental Anxiety ◽

Open Trial ◽

Cognitive Behavioral

BACKGROUND Cognitive behavioral therapy (CBT) is an evidence-based method for treating specific phobias, but access to treatment is difficult, especially for children and adolescents with dental anxiety. Psychologist-guided Internet-based CBT (ICBT) may be an effective way of increasing accessibility while maintaining treatment effects. OBJECTIVE The aim of this study was to test the hypothesis that psychologist-guided ICBT improves school-aged children’s and adolescents’ ability to manage dental anxiety by (1) decreasing avoidance and affecting the phobia diagnosis and (2) decreasing the dental fear and increasing the target groups’ self-efficacy. The study also aimed to examine the feasibility and acceptability of this novel treatment. METHODS This was an open, uncontrolled trial with assessments at baseline, posttreatment, and the 1-year follow-up. The study enrolled and treated 18 participants. The primary outcome was level of avoidance behaviors, as measured by the picture-guided behavioral avoidance test (PG-BAT). The secondary outcome was a diagnostic evaluation with the parents conducted by a psychologist. The specific phobia section of the structured interview Kiddie-Schedule for Affective Disorders and Schizophrenia for School-Age Children-Present and Lifetime (K-SADS-PL) was used. Other outcome measures included level of dental anxiety and self-efficacy. The ICBT, which employed exposure therapy, comprised 12 modules of texts, animations, dentistry-related video clips, and an exercise package (including dental instruments). Participants accessed the treatment through an Internet-based treatment platform and received Web-based guidance from a psychologist. Treatment also included training at dental clinics. Feasibility and acceptability were assessed by measures of engagement, adherence, compliance, completed measures, patient and parent satisfaction scale, and staff acceptability. RESULTS The level of avoidance (according to the primary outcome measure PG-BAT) and dental anxiety decreased and self-efficacy increased significantly (P<.001), within-group effect sizes for both the primary outcome (Cohen d=1.5), and other outcomes were large in the range of 0.9 and 1.5. According to K-SADS-PL, 53% (8/15) of the participants were free from diagnosable dental anxiety at the 1-year follow-up. At the 1-year follow-up, improvements were maintained and clinically significant, with 60% (9/15) of participants who had been unable to manage intraoral injection of local anesthetics before ICBT reporting having accomplished this task at a dental clinic. The target group showed improvement in all the outcome measures. High levels of feasibility and acceptability were observed for the treatment. CONCLUSIONS ICBT is a promising and feasible treatment for dental anxiety in children and adolescents. Integrating it into routine pediatric dental care would increase access to an effective psychological treatment. The results of this open trial must be replicated in controlled studies.

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